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The luxurious appearance of many assisted living communities is their most visible difference from the typical nursing home. It serves as a marketing tool, helping to ease the reluctance that adult children tend to feel about coaxing faltering parents from their homes.

Yet the attention to amenities also reflects an innovative idea about how to help people as they age that the early proponents of assisted living were trying to put into practice.

Although nursing homes represent a medical model of care, the approach to assisted living is a social one. Rejecting nursing homes' often institutional ambience, the industry is built around a more appealing vocabulary, wooing consumers with pledges of dignity, privacy and greater control over their remaining days.

Residents can bring their own furniture and, often, their pets. The emphasis is on personal preferences, large and small: Would you rather comb your own hair, or have it combed? Walk down the hall by yourself, or on the arm of an aide?

This search for a more humane culture of long-term care came on the cusp of an unprecedented surge in the nation's elderly population. The ranks of people 85 and older have doubled since 1980 to 4.3 million, and can be expected to swell to nearly 7 million over the next two decades.

Nearly half the people in that group, census figures show, need help with the mundane activities of their lives -- cooking, taking baths and transportation -- exactly the kind of help that assisted living was designed to provide.

Assisted living was also fostered by broader changes in the U.S. health care system. Because of new medical technologies and efforts to rein in costs, hospitals discharge their patients sooner. Nursing homes have become more specialized, catering to sicker patients.

Assisted living is an effort to enable vulnerable people to live in settings that are more like home. The frail elderly have one other option, home health agencies, which send nurses and aides to help those who can remain in their own houses.

There is no accurate count of how many people assisted living communities house, but estimates range from about 500,000 to 1 million.

Three-fourths of the facilities, industry figures show, have opened since 1996. More than nine out of 10 are owned by for-profit companies -- some of them, such as Bethesda-based Marriott International Inc., with origins in the hospitality business, not health care.

"Assisted living" facilities differ enormously, from small boarding homes for the elderly to large complexes to specialized facilities devoted to people with dementia or other debilitating conditions.

Most are built as free-standing facilities. But a significant number are part of "continuing care" campuses that allow people to move from an independent apartment to assisted living to a nursing home as their health and self-sufficiency erode.